Extra-dural anaesthesia for LSCS; comparison of buprenorphine-0.5 and bupivacaine mixture with plain 0.5 bupivacaine and bupivacaine mixture with plain 0.5 bupivacaine / and bupivacaine mixture with plain 0.5 / bupivacaine

ABSTRACT

[1] To assess the clinical efficacy of Buprenorphine 0.5% Bupivacaine mixture when given extraduraly for caesarean section. [2] To assess the smallest effective dose of each drug in combination. [3] To reduce side effects, whilst providing optimum analgesia. STUDY DESIGN: Double blind trial. PERIOD Jan 1997 to Jan 1998. SETTING: Departments of Anaesthesia and Gynaecology and Obstetrics, Nishtar Hospital Multan. PATIENTS AND METHODS: Seventy patients for elective Caesarean section were allocated randomly to receive extra dural block with 20 ml of either 0.5% bupivacaine mixed with 0.3 mg of buprenorphine or 0.5% Bupivacaine. If the block did not reach T6 within 15 min, another 5 ml of solution was given. If needed, a further 5 ml was given 30 min after the main dose. The mean total dose of Bupivacaine was 23.1 ml [n-35] and of Bupivacaine mixed with 0.3 mg of Buprenorphine 23.7 ml [n=35]. There was no significant difference between the groups in the profile of sensory block produced. There was no significant difference in the time of onset, or intensity of motor block between the groups. The patients in the Buprenorphine 0.5% Bupivacaine group indicated greater satisfaction [86% very satisfied, compared with 43% in the control group [P<0.02]. There was no differences in the incidence of hypotension. However patients in the Buprenorphine-Bupivacaine group had pruritus, nausea and vomiting. There was no significant difference in neonatal outcome, as assessed by Apgar score, umbilical cord blood gas tensions at delivery. CONCLUSIONS: Buprenorphine-Bupivacaine and 0.5% bupivacaine plain produced a similar action and duration of sensory analgesia but combination of Bupivacaine and Buprenorphine produced more satisfactory block for caesarean sections